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“Investment in local health services is a must. Delivery of appropriate health services, particularly through Aboriginal community controlled health services, must be culturally safe, and delivered in the right locations by the right people. Spending on health is an investment. Investing in health must underpin our future policies to Close the Gap, and to address what is, for Australia, a prominent blight on our nation.

Governments and other groups that influence policy cannot do this work themselves. It must be a partnership with Indigenous Australians.

The AMA is committed to working, in partnership with our first peoples to Close the Gap in Indigenous health and disadvantage.”

SPEECH TO BMA SYMPOSIUM The Role of Physicians and National Medical Associations in Addressing the Social Determinants of Health and Increasing Health Equity LONDON 24 MARCH 2015

The Social Determinants of Health: the Australian Perspective

The Australian connotation of the words ‘social determinants’ in relation to health immediately conjure images of the issues faced by Australia’s first people, our Australian Aborigines and Torres Strait Islanders.

And this is rightly so. The social determinants of health are major issues for Australia as a nation in its attempts to ‘close the gap’ for disadvantage of Indigenous people in relation to a range of outcomes, including health.

The implications of the social determinants are not bound by race, although race might be thought of as a social determinant in itself. Social determinants are important to health outcomes for all Australians.

The issues are much more complex than whether someone has a roof over the head, whether they have access to clean water and nutritious food. What I want to talk about, from the Australian perspective, are two issues.

First, there are deeper issues that underlay the social determinants of health. This comes from a sense of physical, social, and emotional wellbeing, the origins of which have deep spiritual roots for Australia’s Indigenous people.

The second is that the term ‘social determinants of health’ is somewhat misleading. While I know many here understand this, we must not forget that health is a determinant of social and other outcomes.

Australian Indigenous peoples represent about 3 per cent of the Australian population. Indigenous Australians experience poor health outcomes. We have a gap between Indigenous and non-Indigenous Australians in terms of health, but also in many other aspects of life. Indeed, the health outcomes are poorer compared to the Indigenous populations of other nations.

Life expectancy of Indigenous Australians is 10.6 years less for men, and 9.5 years for women. This gap in life expectancy is a serious blight on our nation, and remains unacceptable.

The AMA sees that addressing this issue is a core responsibility of the AMA and the medical profession.

While the gap in life expectancy remains unacceptable, there have been gains in Indigenous health. Life expectancy has increased by 1.6 years and 0.6 years for men and women respectively over the past five years. Mortality rates for Indigenous Australians declined by 9 per cent between 2001 and 2012.

So, what are the main contributors to the gap in life expectancy? Chronic diseases are the main contributors to the mortality ‘gap’ between Indigenous and non-Indigenous Australians.

Four groups of chronic conditions account for about two-thirds of the gap in mortality: circulatory disease, endocrine, metabolic and nutritional disorders, cancer, and respiratory diseases.

Another major contributor to the gap in life expectancy is the Indigenous infant and child mortality rate. These rates remain well above that of the non-Indigenous population.

The infant mortality rate remains high at around five deaths per 1000 live births, compared to 3.3 per 1000 for non-Indigenous children.

External causes, such as injury and poisoning, account for around half of all deaths of children aged 1–4 years. External causes, mainly injury, are also the most common cause of death among Indigenous children aged 5–14, and account for half of the deaths in that age group.

The trend data for most States show a 57 per cent decline in the Indigenous infant mortality rate between 2001 and 2012, and a 26 per cent decline in the non-Indigenous rate.

There has been progress here, but clearly there is much more to do.

Suicide was the third leading cause of death among Indigenous males, at six per cent.

The rate of suicide is about two times higher for males and 1.9 for females, compared to non-Indigenous Australians. Suicide also occurs at a younger age. This is not consistent with Aboriginal culture, in which suicide was thought to be rare.

These sorts of reports highlight several important issues.

First, as is already known, non-communicable diseases, in particular circulatory disease and diabetes, remain very significant issues for the Australian Indigenous people.

Investment in local health services is a must. Delivery of appropriate health services, particularly through Aboriginal community controlled health services, must be culturally safe, and delivered in the right locations by the right people.

Second, the rate of suicide, particularly among young Indigenous males, is unacceptably high. This speaks to something much more difficult to address.

It is an issue of how we address mental health, the need to focus on drug and alcohol problems, but it also raises questions about why so many Indigenous people take their own lives.

Third, our child and infant mortality rates are too high, but are improving. What is disturbing is that many of the deaths remain preventable. That is, they are caused by trauma or injury. Some of these injuries will be non-accidental.

While those with chronic disease need to be cared for, prevention, particularly in the early part of life, is the key if we are going to see a generational change in health outcomes.

As a nation, Australia is conscious of the need to improve the health of Indigenous Australians – to Close the Gap.

Each year, the Prime Minister, in the first week that Federal Parliament sits, delivers a report on Closing the Gap.

In 2008, the Council of Australian Governments, or COAG, set six targets aimed at reducing Indigenous disadvantage in relation to health and education.

The Closing the Gap targets are to:

close the life expectancy gap within a generation (by 2031);

halve the gap in mortality rates for Indigenous children under five within a decade (by 2018);

ensure access to early childhood education for all Indigenous four year olds in remote communities within five years (by 2013);

halve the gap in reading, writing and numeracy achievements for children within a decade (by 2018);

halve the gap for Indigenous students in year 12 attainment rates (by 2020); and

halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade (by 2018).

Despite good intention and considerable investment by successive Governments, the disparity in outcomes remains.

As expressed in this year’s Closing the Gap statement by the Prime Minister: ‘It is profoundly disappointing that most Closing the Gap targets are not on track to be met’.

Closing the Gap is an incredibly difficult task, and it is fair to say that Australia and Australians have learnt much about how to Close the Gap over a number of decades.

There were many mistakes, not only in Closing the Gap, but also in how modern Australia has treated Indigenous Australians. These issues have had to be confronted in order to advance efforts to Close the Gap.

For example, from 1910 to 1970, it is estimated that 100,000 Indigenous children were taken from their families and raised in institutions or fostered to non-Indigenous families.

The ‘Stolen Generation’, as they are termed, was disastrous in its outcome, however well-intentioned it may have been – separating families, but also alienating individuals from their own culture and families.

There have been many examples of Governments trying to address the social determinants of health – but often they have failed. For example, the Australian Government attempted to improve the living conditions of Indigenous people by building houses.

The houses were often inappropriate for the location. The plumbing would block because of the hardness of the water. They would fall into disrepair, and they did not serve the needs of the communities. These initiatives were well meaning, but improvements in health outcomes were somewhat marginal.

We have learnt, unfortunately by mistake, but also through partnership with Indigenous Australians. When it comes to health, there is much more to improving Indigenous health than building houses and sending people to school.

The concept of health for Indigenous Australians is very different from that of Western culture. There is no word for health in many Aboriginal languages. Rather, health is more of a concept of social and emotional wellbeing than of physical health.

Even that statement is a generalisation.

Before the arrival of Europeans, Australia was inhabited not by a uniform nation of Aboriginal people, but rather hundreds of ‘Indigenous nations’, whose language varied tremendously, along with their culture and beliefs.

Despite this variation, a unifying theme in terms of that ‘social and emotional wellbeing’ is the connection of Indigenous people with their land.

Australia’s first peoples have been continuously sustained, both physically and spiritually, by their land for 50,000 years of more. They have a deep connection with the land, and it is an important component of maintaining their spiritual wellbeing.

The close connection with the land also means that Indigenous people often live in remote regions. These remote communities present challenges in delivering health care as well as infrastructure and services that improve the social determinants of health.

For Indigenous Australians, their very existence, let alone their lifestyle, was threatened by European settlement as late as 1788. For Indigenous Australians, the arrival of Captain Cook in 1770, and subsequently the First Fleet in 1788, is not seen as European settlement, but rather as a modern invasion.

It signified displacement, imprisonment, forced adoption and much worse. It has left both emotional and spiritual wounds open and unable to heal. Modern economic solutions will continue to fail until these much more deeply seated issues are confronted.

There have been important steps in our young nation’s history that have attempted to approach these issues.

As I mentioned, the attachment to land is an important part of Indigenous culture. For each Indigenous ‘nation’, certain places hold spiritual importance.

From the land stemmed the basis of Aboriginal ‘dreamtime’, the spiritual conceptualisation of the universe and the basis of human existence for Aboriginal peoples. One might say that their landscape was their religion.

Recognition of the longstanding connection to the land came through a series of legislative changes that largely started under the Whitlam Government in 1972. Whitlam established the Aboriginal Land Rights (or Woodward) Commission to examine the possibility of establishing land rights in the Northern Territory.

In 1975, the Whitlam Government purchased traditional land and handed it back to the Gurindji people. In a now famous gesture, Whitlam poured sand into the hands of Vincent Lingiari, an Elder of the Gurindji people.

The Aboriginal Land Rights Act was passed by the Fraser Government in 1976, and established land rights for traditional Aboriginal landowners in the Northern Territory.

In 1992, the doctrine of terra nullius was overruled by the High Court of Australia in Mabo v Queensland, which recognised the Meriam People of Murray Island in the Torres Strait as native title holders over part of their traditional lands.

The Native Title Act was legislated the following year, 1993, by the Keating Government.

Not only did this provide the legal acknowledgement that Indigenous Australians sought, it also provided a source of revenue. The use of land for mining purposes, for example, provided significant funding to Aboriginal people through regional land councils.

More has been done since, but these are important issues to address that underlay social and emotional wellbeing and, therefore, the health of Indigenous people.

In 2008, Prime Minister Kevin Rudd issued a formal apology to Indigenous people for the stolen generation. It had enormous symbolism for Indigenous Australians.

The next likely step is to recognise Australia’s first people in our Constitution.

Constitutional recognition is a vital step towards making Aboriginal and Torres Strait Islander people feel historically and integrally part of the modern Australian nation.

Recognising Indigenous people in the Constitution will improve their self-esteem, their wellbeing, and their physical and mental health.

The AMA is a proud supporter of the Recognise campaign, and is a Foundation Signatory of the campaign.

In 2013, the Abbott Government was elected. Prime Minister Abbott had spent significant amounts of time with Indigenous people, often living for a week at a time in Indigenous communities.

In Government, he ‘ran the country’ for a week from a remote Indigenous community in Arnhem Land of the Northern Territory.

Prime Minister Abbott also took over the responsibilities for many Indigenous policy areas. The coalescence of these responsibilities into the Department of Prime Minister and Cabinet coincided with the reduction of the number of Indigenous programs into five main areas.

The Indigenous Advancement Strategy, or IAS, that began on 1 July 2014 now embodies these aims. The IAS outlines a number of priority areas – getting children to school, adults to work, and making communities safer.

The IAS replaced more than 150 individual programs with five broad programs – Jobs, Land and Economy; Children and Schooling; Safety and Wellbeing; Culture and Capability; and Remote Australia Strategies.

These are all worthy aims. They remain important.

But what is missing from the core of the IAS is a focus on health.

Health, in a modern sense, underpins many of these outcomes. We need to get the balance right and we, the AMA, need to ensure that health is seen as a foundation to these outcomes.

So, what is our role as a national medical association? Our role is to guide politicians and their policies; to shape the national narrative and debate.

The AMA’s Indigenous Health Taskforce, which I chair, draws experts in Indigenous Health together. It highlights the AMA’s commitment to working, in partnership with Indigenous Australians, to improve the health of Indigenous Australians.

Not only do we highlight the problems, but the AMA works on solutions and to highlight the successes as well.

The AMA regularly publishes the AMA Indigenous Report Card.

Last year, we highlighted the importance of a healthy early start to life.

My predecessor, Dr Steve Hambleton stated that: “Robust and properly targeted and sustained investment in healthy early childhood development is one of the keys to breaking the cycle of ill health and premature death among Aboriginal peoples and Torres Strait Islanders.”

Gains can be made by focusing on antenatal care.

In the Pitinjarra lands of north western South Australia there have been major gains in antenatal care, with 75 per cent of all pregnant women seen in the first trimester.

The proportion of children under three years of age with significant growth failure has fallen from 25 per cent in the 1990s to less than 3 per cent today. Immunisation rates approach 100 per cent.

This year, the AMA Report Card will focus on the bigger picture of the importance of health in underpinning the outcomes of education, training, and employment.

We will also focus on the issues of Indigenous incarceration rates, which have continued to escalate.

Law and order policies and health policies are often interlinked. Incarceration leads to a multitude of poorer physical and emotional health outcomes.

Poor health, and a poor start to life, is likely to increase the chances of incarceration. The AMA will be working with the Law Council of Australia on this issue.

To change the health of an entire population is an enormously difficult task. It is too easy for Governments to ignore health, to focus on the economics. Education and economics alone are not sufficient. Health is the cornerstone on which education and economics are built.

If you can’t go to school because you or your family are sick, truancy officers won’t work. If you can’t hear because of otitis media, you won’t learn. If you miss training opportunities because of depression or ill health, you won’t progress to employment. You can’t hold down a job if you keep having sick days.

Spending on health is an investment. Investing in health must underpin our future policies to Close the Gap, and to address what is, for Australia, a prominent blight on our nation.

Governments and other groups that influence policy cannot do this work themselves. It must be a partnership with Indigenous Australians.

The AMA is committed to working, in partnership with our first peoples to Close the Gap in Indigenous health and disadvantage.

As a Goorang Goorang man from Bundaberg QLD I would like to commence by formally acknowledging the traditional owners and custodians of land upon which we meet today and pay my respects to elders both past and present.

I don’t need to tell most of you in the room here today that putting resources into community controlled health can have a great impact: not only in closing the health gap between Aboriginal and mainstream Australia, but also in providing employment and training opportunities and giving an economic boost to Aboriginal and mainstream communities.

Indeed we heard many great examples of this in the presentations and workshops yesterday. There is some amazing work being done across many critical areas within local Communities and I am looking forward to hearing more success stories as the Summit continues over the next two days.

We have all known that Aboriginal Community Controlled Health Services have a flow effect into their communities – indeed most people in this room would have seen it in action.

But at times it has had its challenges for us to provide the definitive proof when asked by policy makers or funders.

Which is why last year NACCHO commissioned research into the economic benefits of Community Controlled Health Services.

We wanted to have something tangible, something that clearly articulated what we were seeing in individual services every day, was a reality across all our services and across the Nation.

So we bought in respected health economist Dr Katrina Alford, where she spent time analysing the statistics that are publicly available, reviewing the data, talking to our services and compiling a comprehensive report which we were fortunate to have been invited to launch earlier this year at the National Press Club.

Of course the report showed just what we had thought it would – that the multiplier effect of our services in terms of employment, training and improving participation of our people is significant.

Our services are large-scale employers of Aboriginal people and in fact the main source of employment in many of our communities.

Lets take a look at a service, one used as a case study in the report – Mulungu.

Mulungi is in Mareeba in far north Queensland, on the Atherton Tablelands about an hour west of Cairns. Mareeba has a population of around 10,000 people and about thirteen per cent of those are Australia’s First Peoples.

Mulungi provides employment for 41 people in this small town, thirty being Aboriginal and Torres Strait Islander people from the local community. Aboriginal employment at Mulngu accounts for more than 12 per cent of all the Aboriginal employment in the area and wages and salaries in excess of $2.6 million a year

That’s a huge economic contribution, not just to the local Aboriginal community, but to the broader community of Mareeba.

Mulngu is not alone. Our 150 Aboriginal Community Controlled Health Services employ more than 5,500 people across the country and more than 3,500 of those are Aboriginal and Torres Strait Islanders.

That’s a very high number of people who have meaningful, secure jobs – participating in the labour market and in many cases effectively breaking the welfare cycle that can persist in some of our communities.

They provide wages and salaries that are much higher than the average Aboriginal Australian income which is use to support their families, take into their communities and boost regional economies.

The ripple effect of this employment cannot be underestimated and so our services are providing a solution to one of the key challenges we need to address if we are to reduce the chronic unemployment rates of our people.

Many of us here today, including myself can testify of the opportunities and experiences that were made available to many of us as younger Aboriginal & Torres Strait Islander men and women starting out our careers were given through our local Aboriginal Community Controlled Health Organisations.

This includes being mentored by inspiring, incredible and visionary Aboriginal people – that taught us the importance of “Aboriginal health in Aboriginal hands”.

Learning on the job, raising educational levels and earning our stripes along the way. I doubt whether we could have achieved so much if it hadn’t been for opportunities and privileges to learn and be developed in such a nurturing and culturally sensitive environment.

Sadly however, although we are slowly seeing some improvements, many of the Aboriginal and Torres Strait Islander health workforce suffer institutionalized racism in the mainstream system and many have their career paths stunted.

Yet, in an Aboriginal Community Controlled Health environment, the Aboriginal and Torres Strait Islander health workforce employees in the main flourish.

And as they do so they provide culturally appropriate, culturally safe, holistic health care which our people want to use.

They combine clinical know-how with culturally enriched local knowledge and wisdom.

We are seeing demand for our services rising at a rate of six per cent a year as more and more of our people seek our the care of the local services where they know they will be treated without judgment, but with respect and dignity.

People come to use our Services from far and wide – there are many examples of /Community members traveling many kilometres and considerable time to access our member services and in some cases by-passing mainstream health services on the way to our “culture centres of Comprehensive Primary Health Care”

Aboriginal Community Controlled Health Organisations

The trend toward Aboriginal people seeking check ups at their local Aboriginal Community Controlled Health service means we are starting to diagnose earlier, make real inroads into reducing risk taking behavior’s like smoking, and putting preventative health measures in place.

And as a result it is our services that are reducing child mortality by 66 per cent, and reducing overall Aboriginal and Torres Strait Islander mortality rates by 33 per cent.

This in turn is slowly reducing the pressure and costs at the chronic end of the scale, reducing the need for hospitalisation and acute care.

And so again we see that our services are ticking numerous boxes in the struggle to close the gap between Aboriginal and white Australia:

Health – tick
Employment – tick
Training – tick.

Indeed, a single investment in Aboriginal Community Control Health Organisations deals with all three of the main challenges in Aboriginal communities:

High unemployment

Low education levels

And poor health

It is hard, then, to argue against the proposition that investing in Aboriginal community controlled health makes economic sense.

And yet we are still fighting for that investment.

It’s true that ACCHOs funding was renewed for 12 months just prior to the Federal Budget and that was welcome given the climate of spending cuts in all areas and particularly across the board in Aboriginal affairs.

But let’s face it – this is a long way short of what is needed – long term surety and security for our services and the large numbers of people they employ.

Plus many of the programs we run outside of the core funding are still up in the air. Indigenous health spending was cut by millions in the Budget and we are still waiting to see what that will mean for us on the ground.

The introduction of the medicare co-payment will hurt our services and given most will absorb the cost rather than pass it on to their clients, it will effectively result in a cut to their operating budget.

The next twelve months will be telling.

At NACCHO we will be fighting for five-year funding agreements, such as are given to the pharmacy guild, alongside a reduction in the masses of administrative red tape which divert many of services from providing care.

We will also continue to argue at the national level for ACCHOs to be exempt from any co-payments. We simply can’t afford for there to be any barriers to Aboriginal people seeking medical advice and seeking it early.

Introducing the co-payment will take us one step backwards and in Aboriginal health we need to keep moving forward or our gains will be lost.

We have worked hard over the years to develop our multi-partisan relationships with key decision makers at the highest levels and I believe we are getting some traction.

I take it as a positive sign that the Assistant Minister for Health Fiona Nash took up the invitation to speak at the Summit yesterday. She also said on the public record in a recent press release, and I quote:

“The Government recognises that while some improvements in Indigenous health outcomes have been achieved over recent years, there is still a long way to go to close the gap between the health and life expectancy of Aboriginal and Torres Strait Islander people and non-Indigenous Australians.”

“The role that Aboriginal Community Controlled Health Organisations continue to play in the delivery of health services to Aboriginal and Torres Strait Islander people is therefore vital.”

She may be convinced, but we are yet to see how this may be realised by other politicians, our collective job is to make sure every other Member of Parliament is also convinced, so when it comes down to a decision by the Treasurer on where he puts his funding, every Member of Parliament is an advocate for our movement of Aboriginal Community Controlled Health Organisations Programs, run by our member services for diabetes, chronic disease, smoking, maternal health and there is more, we need local, state and federal decision makers to physically see our best practice models.

We have a goal over the next 8-10 months to have every MP visit their local ACCHO – see first hand what goes on in our services, to get a better sense of the great work that is being done in electorates across the country, and to see for themselves the real social and economic benefit of community controlled health.

Together we are a strong and powerful entity unmatched by any group or sector in this Nation. We as Aboriginal Community Controlled Health Organisations is the door for MP’s to gain first hand experience, so in this NACCHO has created an MP kit to assist in guideing on how to engage with local MP’s. Many already have long-standing relationships, but there are a number of newly elected MP’s and many more who may never have stepped inside an ACCHO.

If there is ever a time for our us to think and act strategically “with one voice” it is now.

We have the structure across local, State and National levels, we have great support from other State and National health bodies. The next 3-6 months will prove to be nothing short of extreme importance not only for our member services today but into future years.

Aboriginal Controlled Health has proven over 4 decades that we are the vehicle in addressing Aboriginal Health and the cultural connection between clinical and traditional healing of the physical, emotional and spiritual wellbeing our our people.

“On an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people.

Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.”

“If you (Indigenous patient) go to a health service and you’re made to feel unwelcome, or uncomfortable or not deserving or prejudged and there are lots of scenarios of Aborginal people being considered to be perhaps being seriously intoxicated when in fact they’ve been seriously ill.”

It’s well known that Indigenous Australians have much lower life expectancy than other Australians, and have disproportionately high rates of diseases and other health problems.

Could that in part be due to racism?

The Social Determinants of Health Alliance is a group of Australian health, social services and public policy organisations.

It lobbies for action to reduce inequalities in the outcomes from health service delivery.

Chair of the Alliance, Martin Laverty, has no doubt racism sometimes comes into play when Indigenous Australians seek medical attention.

“When an Indigenous person is admitted to hospital, they face twice the risk of death through a coronary event than a non-Indigenous person and concerningly, Indigenous people when having a coronary event in hospital are 40 percent less likely to receive a stent* or a coronary angiplasty. The reason for this is that good intentions, institutional racism is resulting in Indigenous people not always receiving the care that they need from Australia’s hospital system.”

Romlie Mokak is the chief executive of the Australian Indigenous Doctors’ Association.

Mr Mokak says the burden of ill health is already greater amongst Indigenous people – but this isn’t recognised when they go to access health services.

“Whereas Aboriginal people may present to hospitals often later and sicker, the sort of treatment they might get once in hospital, is not necessarily reflect that higher level of ill health. We’ve got to ask some questions there and why is it that the sickest people are not necessary getting the equitable access to healthcare.”

Mr Mokak says many Indigenous people are victims of prejudice when seeking medical services.

“If you (Indigenous patient) go to a health service and you’re made to feel unwelcome, or uncomfortable or not deserving or prejudged and there are lots of scenarios of Aboriginal people being considered to be perhaps being seriously intoxicated when in fact they’ve been seriously ill.”

But Romlie Mokak from the Australian Indigenous Doctors Association says the onus shouldn’t be on the federal government alone to improve the situation.

He suggests cultural awareness training for health professionals would reduce the incidence of racism.

“Not only is it at the point of the practitioner, but it’s the point of the institution that Aboriginal people must feel that they are in a safe environment. In order to do this, it’s not simply that Aboriginal people should feel resilient and be able to survive these wider systems, but those services really need to have staff that have a strong understanding of Aboriginal people’s culture, history, lived experience and the sorts of health concerns they might have and ways of working competently with Aboriginal people.”

Martin Laverty says at a recent conference, data was presented suggesting an increase in the number of Australians experiencing racism.

And he says one of the results is an increase in psychological illnesses.

“We saw evidence that said about 10 percent of the Australian population in 2004 was reporting regular occurences of individual acts of racism and that that has now double to being close to 20 percent of the Australian population reporting regular occurences of racism. We then saw evidence that the consequences of this are increased psychological illnesses. Psychological illnesses tied directly to a person’s exposure to racism and discrimination and that this is having direct cost impacts of the Australian mental health and broader acute health system.”

Mr Laverty says it’s time governments acknowledged and addressed the impact of factors such as racism on health outcomes.

He says a good start would be to implement the findings of a Senate inquiry into the social determinants of health, released last year.

“In the country of the fair go, we should be seeing Australian governments, Australian communities acting and indentifying these triggers of racism that are causing ill health and recognising that this is not just something the health system that needs to respond to, but the Australian government can respond by implementing the Senate inquiry of March 2013 that outlines the set of steps that can be taken to overcome these detriments of poor social determinants of health.”

Racism a driver of Aboriginal ill health

On an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people. Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.

In July 2013, the former federal government launched its new National Aboriginal and Torres Strait Islander Health Plan.

As with all such plans, much depends on how it is implemented. With the details of how it is to be turned into meaningful action yet to be worked out, many Aboriginal and Torres Strait Islander people, communities and organisations and others will be reserving their judgment.

Nevertheless, there is one area in which this plan breaks new ground, and that is its identification of racism as a key driver of ill-health.

This may be surprising to many Australians. The common perception seems to be that racism directed towards Aboriginal and Torres Strait Islander people is regrettable, but that such incidents are isolated, trivial and essentially harmless.

Such views were commonly expressed, for example, following the racial abuse of Sydney Swans footballer Adam Goodes earlier this year.

However, the new health plan has got it right on this point, and it is worth looking in more detail at how and why.

So how common are racist behaviours, including speech, directed at Aboriginal and Torres Strait Islander people?

A key study in Victoria in 2010-11, funded by the Lowitja Institute, documented very high levels of racism experienced by Aboriginal Victorians.

It found that of the 755 Aboriginal Victorians surveyed, almost all (97 per cent) reported experiencing racism in the previous year. This included a range of behaviours from being called racist names, teased or hearing jokes or comments that stereotyped Aboriginal people (92 per cent); being sworn at, verbally abused or subjected to offensive gestures because of their race (84 per cent); being spat at, hit or threatened because of their race (67 per cent); to having their property vandalised because of race (54 per cent).

Significantly, more than 70 per cent of those surveyed experienced eight or more such incidents in the previous 12 months.

Other studies have found high levels of exposure to racist behaviours and language.

Such statistics describe the reality of the lived experience of Aboriginal and Torres Strait Islander people. Most Australians would no doubt agree this level of racist abuse and violence is unwarranted and objectionable. It infringes upon our rights – not just our rights as indigenous people but also our legal rights as Australian citizens.

But is it actually harmful? Is it a health issue? Studies in Australia echo findings from around the world that show the experience of racism is significantly related to poor physical and mental health.

There are several ways in which racism has a negative effect on Aboriginal and Torres Strait Islander people’s health.

First, on an individual level, exposure to racism is associated with psychological distress, depression, poor quality of life, and substance misuse, all of which contribute significantly to the overall ill-health experienced by Aboriginal and Torres Strait Islander people. Prolonged experience of stress can also have physical health effects, such as on the immune, endocrine and cardiovascular systems.

Second, Aboriginal and Torres Strait Islander people may be reluctant to seek much-needed health, housing, welfare or other services from providers they perceive to be unwelcoming or who they feel may hold negative stereotypes about them.

Last, there is a growing body of evidence that the health system itself does not provide the same level of care to indigenous people as to other Australians. This systemic racism is not necessarily the result of individual ill-will by health practitioners, but a reflection of inappropriate assumptions made about the health or behaviour of people belonging to a particular group.

What the research tells us, then, is that racism is not rare and it is not harmless: it is a deeply embedded pattern of events and behaviours that significantly contribute to the ill-health suffered by all Aboriginal and Torres Strait Islander Australians.

Tackling these issues is not easy. The first step is for governments to understand racism does have an impact on our health and to take action accordingly. Tackling racism provides governments with an opportunity to make better progress on their commitments to Close the Gap, as the campaign is known, in Aboriginal and Torres Strait Islander health. The new plan has begun this process, but it needs to be backed up with evidence-based action.

Second, as a nation we need to open up the debate about racism and its effects.

The recognition of Aboriginal and Torres Strait Islander peoples in the Constitution is important for many reasons, not least because it could lead to improved stewardship and governance for Aboriginal and Torres Strait Islander health (as explored in a recent Lowitja Institute paper, “Legally Invisible”).

However, the process around constitutional recognition provides us with an opportunity to have this difficult but necessary conversation about racism and the relationship between Australia’s First Peoples and those who have arrived in this country more recently. Needless to say, this conversation needs to be conducted respectfully, in a way that is based on the evidence and on respect for the diverse experiences of all Australians.

Last, we need to educate all Australians, especially young people, that discriminatory remarks, however casual or apparently light-hearted or off-the-cuff, have implications for other people’s health.

Whatever approaches we adopt, they must be based on the recognition that people cannot thrive if they are not connected.

Aboriginal and Torres Strait Islander people need to be connected with their own families, communities and cultures. We must also feel connected to the rest of society. Racism cuts that connection.

At the same time, racism cuts off all Australians from the unique insights and experiences that we, the nation’s First Peoples, have to offer.

Seen this way, recognising and tackling racism is about creating a healthier, happier and better nation in which all can thrive.

Pat Anderson is chairwoman of the Lowitja Institute, Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research.

On behalf of the NACCHO Board and Secretariat it is my pleasure to invite you to submit an abstract to the NACCHO Healthy Futures Summit at the Melbourne Convention and Exhibition Centre 24-26 June 2014.

The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.

NACCHO would like to demonstrate to the government at this summit how investing more in ACCHS is the best way of promoting better health more employment, more jobs and greater community economic benefits.

NACCHO Healthy futures Summit-Melbourne 24-26 June 2014

NACCHO invites abstracts submission from its members the Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholder organisations to showcase policy frameworks, best practice and investment in Aboriginal Health.

The delegates will be a representation from all over Australia in clinical practice, policy and research.

2.Health Reform

2.1 Workforce

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

National, State, Regional and Local Workforce Needs Analysis

Models of success

Recruitment and Retention Strategies

Mentoring Programs

Workforce Innovation Partnership

Career pathways that incorporate Scope of Practicewithin ACCHO’s

2.2 Continuous Quality Improvement

Affiliate Registered Training Organisations Capacity Building of ACCHO’s through scope of practice

Accreditation

Clinical Standards

3.Healthy Futures

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

Clinic Practice/frontline servicing

Mental Health

Social Emotional Wellbeing

Drug & Alcohol

Mums & Babies

Women’s Health

Men’s Health

Oral Health

Aged Care

Disabilities

Adolescent

Sexual Health

4.Youth

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

Investment in Youth by Aboriginal Community Controlled Health Organisations

Career pathways within an ACCHO, Affiliates and key stakeholders

Youth Leadership

Mentoring

Healthy Lifestyles and Youth

Health Promotion Strategies

5.Research & Data

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

Population Health

Best practice models

Gap and Needs analysis

Research within Aboriginal Community Controlled Health Organisations

Research Partnerships

Health Information

Importance of Data

Cultural protocols into practice

What’s the Aboriginal Community Controlled Health Data telling us?

General guidelines for submissions

Abstracts will only be accepted by submitting through the online process below .

Abstracts must be a maximum of 300 words .

All abstracts must be original work.

The abstract will contain text only; no diagrams, illustrations, tables or graphics.

All presenting authors must register and pay for their registration for the conference by 18 April 2014 otherwise the presentation will be removed from the program.

The NACCHO advisory group reserves the right to accept and reject abstracts for inclusion in the program and allocate to a format that may not have been initially specified by the author/presenter.

The conference organisers will not be held responsible for submission errors caused by internet service outages, hardware or software delays, power outages or unforeseen events.

It is the responsibility of the presenting author to ensure that the abstract is submitted correctly. After an author has submitted their abstract, they should check their abstract was uploaded successfully.

All authors will receive notification of the outcome of their submission on 4 April 2014.

Responsibility for the accuracy of abstracts rests with the author.

Where there are co-authors, only one abstract is to be submitted. The presenting author is responsible for ensuring the co-authors agree with and are aware of the content before submitting the abstract.

An abstract which does not adhere to these requirements will not be accepted

The Chair of the Committee, Dr Sharman Stone, said that ‘The Committee is not singling out Aboriginal and Torres Strait Islander people as the only group that have problems with alcohol.

We know that Aboriginal and Torres Strait Islander people are more likely to abstain from alcohol than non- Aboriginal and Torres Strait Islander people. However we are concerned that Aboriginal and Torres Strait Islander people, who do consume alcohol, drink at riskier levels which has a greater impact on their health.’

Dr Stone said ‘while there is no doubt that alcohol abuse has a significant impact on families and communities right across Australia, Aboriginal and Torres Strait Islander people are between four and five times more likely to be hospitalised, and between five and eight times more likely to die as a result of harmful alcohol use

‘Statistics such as these are of great concern. The Minister has supported the Committee’s determination to identify the social and other determinants of high risk alcohol consumption. We will also identify the strategies and programs which may have had some beneficial outcomes, comparing international experience. The prevalence and impacts of FASD and FAS will also be given a particular focus. We wish to hear from specialists and communities about what is working and why and submissions are now being called for.’

The Committee will inquiry into and report on:

Terms of Reference

The Committee will inquire into and report on the harmful use of alcohol in Aboriginal and Torres Strait Islander communities, with a particular focus on:

• Patterns of supply of, and demand for alcohol in different Aboriginal and Torres Strait Islander communities, age groups and genders

• The social and economic determinants of harmful alcohol use across Aboriginal and Torres Strait Islander communities

“Closing the gap requires a coordinated approach at the state and federal levels as the challenges faced by Aboriginal people are interconnected.You can’t improve overall health outcomes without also looking at the social determinants, things like housing, education and poverty. Similarly, you can’t improve health outcomes while the numbers of Aboriginal people in our jails continues to rise,”

“Congress calls upon the Prime Minister to show leadership and understanding of the need for increased capacity in our organisations and communities. He can demonstrate that by ensuring the National Aboriginal and Torres Strait Islander Legal Services is retained and strengthened,”

Said Co-Chair National Congress Les Malezer.(see press release below)

Overview

Yesterday the Federal Government delivered the Mid Year Economic and Fiscal Outlook 2013-2014.

Here are some things from the report as they relate to Aboriginal Affairs and Aboriginal Health and Health more broadly.

NACCHO Press release

National Aboriginal Community Controlled Health Organisation (NACCHO) Chair, Justin Mohamed, said cutting legal services made no economic sense when you take into account the wider implications of incarceration on issues such as employment, education and health.

“The fact is people in our jail system often suffer from poor mental and physical health,” Mr Mohamed said.

“Incarceration also can have broader impacts on the health of those left behind – on the imprisoned person’s family and broader community.

“With rates of incarceration of Aboriginal people increasing, we should be doing everything we can to turn around the huge numbers of Aboriginal people in our prisons.

“NACCHO supports the good work of the National Aboriginal and Torres Strait Islander Legal Services and Aboriginal and Torres Strait Islander Legal Services – both who play an important role in keeping our people out of jail.

“They provide education and early intervention support and advice which can mean the difference between a life of incarceration and one that makes a contribution to the community.

“The Federal Government need to rethink their position and recognise how crucial a national voice on Aboriginal legal policy is in reducing the disproportionate numbers of Aboriginal people in the justice system.

“Aboriginal peak bodies understand better than anyone the issues their people face and the factors that contribute to them entering the justice system.

“Taking that voice from the mix to save a few dollars will just hamper future efforts to improve outcomes across a range of factors including health, education and employment.”

Mr Mohamed said closing the gap between Aboriginal and non-Aboriginal people needed an integrated approach.

“Aboriginal people make up more than thirty percent of the prison population, despite being only a fraction of the Australian population.

“Closing the gap requires a coordinated approach at the state and federal levels as the challenges faced by Aboriginal people are interconnected.

“You can’t improve overall health outcomes without also looking at the social determinants, things like housing, education and poverty. Similarly, you can’t improve health outcomes while the numbers of

Aboriginal people in our jails continues to rise,” Mr Mohamed said.

National Congress Condemns Cuts

The National Congress of Australia’s First Peoples (Congress) strongly opposes the decision by the Federal Government to cut funding to community controlled Aboriginal and Torres Strait Islander organisations.

The government’s ‘hit or miss’ funding cuts to our organisations, at the beginning of their term and before the completion of their highly-publicised inquiries, endangers the collaborative approach offered by the Prime Minister.

Today’s news that the national body for the Aboriginal and Torres Strait Islander Legal Services is to be defunded is a significant blow and does not reflect an effort to engage in partnership.

Having a national body for the legal services increases the skills, experience and effectiveness of all the Aboriginal and Torres Strait Islander Legal Services, and brings greater efficiency to the expenditure incurred by those legal services.

“Congress calls upon the Prime Minister to show leadership and understanding of the need for increased capacity in our organisations and communities. He can demonstrate that by ensuring the National Aboriginal and Torres Strait Islander Legal Services is retained and strengthened,” said Co-Chair Les Malezer.

“Our Peoples must be self-determining and will not accept Governments making decisions on funding priorities without us.

“Removing our capacity for policy reform and advocacy to legal assistance programs delivered by Aboriginal, community and legal aid services will affect the most marginalised and vulnerable members of our community.

“We cannot accept any reduction in Commonwealth spending on housing, remote infrastructure, legal services, community safety, native title, languages and culture, when investment and capacity building is what’s clearly required.

“We will continue to work with the Commission to engage with all of our members.

“Community input and ownership are highlighted as keys to achieve improvements by the Government’s own landmark reports – including the Department of Finance Strategic Review of Indigenous Expenditure (2011) and the Overcoming Indigenous Disadvantage: Key indicators 2011 report,” said Ms Parker.

“This cost cutting measure from the Government is deeply disappointing and will further undermine efforts to deliver on our Closing the Gap commitments,” Senator Rachel Siewert, Australian Greens spokesperson on Aboriginal and Torres Strait Islander Issues.

“The role of Coordinator General is to ‘monitor, assess, advise and drive progress relating to improvements in government service delivery in 29 remote Indigenous communities across Australia’.

Removing this role will directly affect the ability of the Government to monitor and report on the implementation of policies.

“This cut is a comparatively small amount of money that the Government admits will be used to either save money or fund other, unnamed policies.

It isn’t even being reinvested in other programs to help people in remote Australia.

“Decisions such as this make a mockery of Tony Abbott’s comments about being the Prime Minister for Indigenous Affairs, as once again his Government seeks to avoid scrutiny and accountability for its policies,” Senator Siewert concluded.

A paper released last week on the Closing the Gap Clearinghouse website examines the beneficial effects of participation in sports and recreation for supporting healthy Aboriginal and Torres Strait Islander communities.

It shows that there are many benefits to Aboriginal and Torres Strait Islander communities from participation in sport and recreational programs, including some improvements in school retention, attitudes towards learning, social and cognitive skills, physical and mental health and wellbeing; increased social inclusion and cohesion; increased validation of and connection to culture; and some evidence of crime reduction.

The paper shows that although the effects of sports and recreation programs can be powerful and transformative, these effects tend to be indirect and therefore hard to measure.

For example, programs to reduce juvenile antisocial behaviour largely work through diversion—these can provide alternative and safer opportunities for risk-taking, for maintenance of social status, and in building healthy relationships with elders.

Because of the lack of direct measures on the impact of sports and recreation programs on various outcomes for Indigenous Australians, this resource sheet focussed on some of the principles that can help ensure that the program is successful. These include:

Linking sports and recreation programs with other services and opportunities;

Promoting a program rather than a desired outcome;

Engaging the community in the planning and implementation of programs, as this will ensure that the program is culturally appropriate, and potentially sustainable.

What we know

• There is some evidence, in the form of critical descriptions of programs and systematic reviews, on the benefits to Aboriginal and Torres Strait Islander communities from participation in sport and recreational programs. These include some improvements in school retention, attitudes towards learning, social and cognitive skills, physical and mental health and wellbeing; increased social inclusion and cohesion; increased validation of and connection to culture; and crime reduction.

• Although the effects of sports and recreation programs can be powerful and transformative, these effects tend to be indirect. For example, using these programs to reduce juvenile antisocial behaviour largely work through diversion, providing alternative safe opportunities to risk taking, maintenance of social status, as well as opportunities to build healthy relationships with Elders and links with culture.

• Although Indigenous Australians have lower rates of participation in sport than non-Indigenous people, surveys suggest that around one-third of Indigenous people participate in some sporting activity (ABS 2010). That makes sports a potentially powerful vehicle for encouraging Indigenous communities to look at challenging personal and community issues.

• Within Indigenous communities, a strong component of sport and recreation is the link with traditional culture. Cultural activities such as hunting are generally more accepted as a form of sport and recreation than traditional dance. Therefore sport and recreation are integral in understanding ‘culture’ within Indigenous communities, as well as highlighting the culture within which sport and recreation operate.

What works

There are a range of benefits pertaining to participation in sports and recreation activities. In the absence of evaluation evidence, below is a list of principles of ‘what works’ and ‘what doesn’t work’ to assist with sport and recreation program implementation.

• Providing a quality program experience heightens engagement in the sports or recreational activity.

• Where no activity has been previously made available, offering some type of sport or recreation program to fill that void should be given priority over making selective decisions about which program to carry out.

• Linking sports and recreation programs with other services and opportunities (for example, health services or counselling; jobs or more relevant educational programs) improves the uptake of these allied services. This assists in developing links to other important programs for improving health and wellbeing outcomes, or behavioural change.

• For sporting programs, providing long-term sustained, regular contact between experienced sportspeople and participants allows time to consolidate new skills and benefits that flow from involvement in the program.

• Promoting a program rather than a desired outcome improves the uptake of activities—for example, a physical fitness program is more likely to be well used if promoted as games or sports rather than a get-fit campaign.

• Involving the community in the planning and implementation of programs promotes cultural appropriateness, engagement and sustainability.

• Scheduling activities at appropriate times enhances engagement—for example, for young people, after school, weekends and during school holidays, when they are most likely to have large amounts of unsupervised free time.

• Creating a safe place through sports or recreation activities, where trust has been built, allows for community members to work through challenges and potential community and personal change without fear of retribution or being stigmatised.

It’s time to move away from the deficit model that is implicit in much discussion about the social determinants of health, and instead take a strengths-based cultural determinants approach to improving the health of Aboriginal and Torres Strait Islander people. This is one of the messages from Ngiare Brown, Professor of Indigenous Health and Education at the University of Wollongong.

Professor Brown also stresses the importance of a focus on resilience, and the value of the Aboriginal Community Controlled Health sector as a national network for promoting cultural revitalisation and sustainable intergenerational change.

The summary below is taken from her presentation at the recent NACCHO summit

***

Connections to culture and country build stronger individual and collective wellbeing

Professor Ngiare Brown writes:

Although widely accepted and broadly researched, the social determinants approach to health and wellbeing appear to reflect a deficit perspective – demonstrating poorer health outcomes for those from lower socioeconomic populations, with lower educational attainment, long term unemployment and welfare dependency and intergenerational disadvantage.

The cultural determinants of health originate from and promote a strength based perspective, acknowledging that stronger connections to culture and country build stronger individual and collective identities, a sense of self-esteem, resilience, and improved outcomes across the other determinants of health including education, economic stability and community safety.

Exploring and articulating the cultural determinants of health acknowledges the extensive and well-established knowledge networks that exist within communities, the Aboriginal Community Controlled Health Service movement, human rights and social justice sectors.

Consistent with the thematic approach to the Articles of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), cultural determinants include, but are not limited to:

•Self-determination;

•Freedom from discrimination;

•Individual and collective rights;

•Freedom from assimilation and destruction of culture;

•Protection from removal/relocation;

•Connection to, custodianship, and utilisation of country and traditional lands;

•Reclamation, revitalisation, preservation and promotion of language and cultural practices;

•Protection and promotion of Traditional Knowledge and Indigenous Intellectual Property; and

•Understanding of lore, law and traditional roles and responsibilities.

The power of resilience

The exploration of resilience is a powerful and culturally relevant construct.

Resilience may be defined as the capacity to “cope with, and bounce back after, the ongoing demands and challenges of life, and to learn from them in a positive way”, positive adaptation despite adversity or “a class of phenomena characterized by good outcomes in spite of serious threats to adaptation or development”

Resilience is important because:

• It is culturally significant – we are a resilient culture, surviving and thriving;

• Resilient people/communities are better prepared for stronger, smarter, healthier, successful futures and have better outcomes across the social determinants of health (education, health, employment);

• Resilient individuals are more likely to provide a positive influence on those around them and are better able to develop and maintain positive relationships with others – family, friends, peers, colleagues;

The cultural determinants of health and wellbeing may be seen to be wrapping around, or cutting across individual, internal, external and collective factors.

A ‘social and cultural determinants’ approach recognises that there are many drivers of ill-health that lie outside the direct responsibility of the health sector and which therefore require a collaborative, inter-sectoral approach.

There is an increasing body of evidence demonstrating that protection and promotion of traditional knowledge, family, culture and kinship contribute to community cohesion and personal resilience.

Current studies show that strong cultural links and practices improve outcomes across the social determinants of health.

There are certain services only NACCHO and ACCH sector can and should do – child protection; mental health; women’s business; and men’s health.

This is useful in assisting policy and resourcing decision-making dependent upon context, geography, demography and tailoring services to local needs and priorities

The ACCH sector provides a true national network and a vehicle for cultural revitalisation. A cultural determinants approach and cultural revitalisation drive sustainable intergenerational change.

Inaugural Aboriginal health summit: why Aboriginal community control works

The National Aboriginal Community Controlled Health Organisation (NACCHO) will hold their first ever National Aboriginal Primary Health Care Summit in Adelaide later this month.

NACCHO Primary Health Care Summit

20th-22nd August 2013

Adelaide Convention Centre

The inaugural summit, which goes for three days, will bring health service professionals from around the country together to discuss national, state and local best practice in health management, and focus on three key themes: primary health care, governance, and workforce.

10 great reasons why you should not miss the NACCHO summit In Adelaide

Inspiring speakers

Opportunities to meet old friends and make new ones

Practical take-home ideas

Entertainment

Resources to equip you

What about ‘Three streams of break-out sessions each day’

Social events

Opportunities to partner with other organisations and people from inside and beyond the ACCH sector

NACCHO Chair, Justin Mohamed (pictured above left with Megan Davis and Deputy Matthew Cooke) said the Health Summit was a great opportunity to showcase the incredible contribution Aboriginal Community Controlled Health Organisations are making in their communities.

“We have concrete evidence that Aboriginal health in Aboriginal hands is what is really making the difference in achieving health outcomes for our people,” Mr Mohamed said.

“We are seeing big improvements in child birth weights, maternal health and management of chronic diseases like diabetes, highlighted recently in a report by the Australian Institute of Health and Welfare (AIHW) Healthy for Life Report Card.

“The Aboriginal community controlled health model has been working well for 40 years, and it is important that we get together to share best practice and discuss issues and areas where we can make improvements.

“Over the three days, summit participants will hear from Aboriginal leaders who are making a real difference in their communities.

“Our culturally appropriate health providers with majority Aboriginal governance are not only providing comprehensive primary health care to just under half of Australia’s total Aboriginal and Torres Strait Islander population, but are one of the largest employers of Aboriginal people as well.

“There is still a long way to go to Close the Gap and to build a healthy future for all Aboriginal and Torres Strait Islander people. Aboriginal Community Controlled Health Organisations are part of this picture and achieving targets to deliver better health outcomes.

Prominent Aboriginal Territorian and the current CEO of Danila Dilba Health Service Olga Havnen argues that the “fault lines” between politicians, bureaucrats and NGOs and the Aboriginal Community Controlled Health sector must unite to make a real difference.

A little known positive aspect of the Northern Territory Intervention was a significant increase in resources to Aboriginal Comprehensive Primary Health Care.

This, along with parallel initiatives under Closing the Gap, gave some hope that the decades long demands from our sector for substantial extra resources in primary health care was at last being heard.

However, while we have been making some advances in the Northern Territory, we face the potential for a “race to the bottom” in Aboriginal health where the interests of politicians, bureaucrats and NGOs potentially outweigh the evidence of Aboriginal community control.

Prominent Aboriginal Territorian and the current CEO of Danila Dilba Health Service Olga Havnen argues that the “fault lines” between these groups and the Aboriginal Community Controlled Health sector must unite to make a real difference.

Extract from the 16 pages speech which can now be download from NACCHO

I am currently the CEO of Danila Dilba Health Service in Darwin, which has not long ago celebrated its 20th anniversary. We are an Aboriginal Community Controlled Health Service—and part of a broader, national movement of community controlled comprehensive primary health care that has its origins in Redfern some 42 years ago.

At the core of what we have achieved over those many years has been an aggressive approach to basing our work on evidence. Our accumulated achievements have always been based on what works—in clinical as well as social practice.

At the heart of what we have strived to achieve is the development of a practice—both clinical and social—that displays our strong and central commitment to comprehensive primary health care.

This model was codified at an international level at Alma Ata in 1978, and subsequently endorsed by the World Health Organisation (WHO) and the United Nations:

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

REMOTE indigenous communities are suffering from a government culture of “risk intolerance” which has diverted funding from community-led organisations, a leading Aboriginal figure has said.

Olga Havnen, the Northern Territory’s former co-ordinator general for remote services, last night attacked successive governments for choosing large non-government organisations for service delivery ahead of smaller indigenous-led organisations.

Ms Havnen said many community-led service delivery organisations had “disappeared” since the Northern Territory Emergency Response in 2007.

“Aboriginal control of service delivery in many areas has withered on the vine,” she said in the Lowitja O’Donoghue Oration at the University of Adelaide.

“Despite jurisdictional, national and international evidence that community control over service delivery achieves better results, with control being a key element in the social determinants of health, for example, we have gone backwards.”

Ms Havnen, whose position in the Territory was abolished by the new Country Liberal Party government in October, said there had been a “massive expansion” of NGO involvement in service delivery with “many millions of dollars” flowing to non-indigenous NGOs and multinational NGOs, regardless of their effectiveness.

She said in the past decade, only one new community controlled health service had been established in the Territory and only two remote health clinics handed across to community control.

“It is a process which has allowed government agencies to quarantine themselves from what they too often ascribe as risk in funding Aboriginal organisations,” she said.

“By this I mean that nothing is done, or can be done, that might in any way shape or form come back to haunt politicians or bureaucrats at a Senate estimates hearing or their state and territory equivalents.”

Ms Havnen, who is now chief executive of the Danila Dilba Health Service in Darwin, an Aboriginal community controlled health service, said that there needed to be a fundamental change in the relationship between Aboriginal service delivery in the Territory and elsewhere, and politicians, bureaucrats and NGOs who were involved in the process.

“The politicians and public servants can be agents of innovation and change if they abandon risk intolerance,” she said.

“Similarly, the response of NGOs to the last decade or so of reaping the benefits of government funding into Aboriginal service delivery must also change.

“Risk intolerance cannot be part of Closing the Gap.”

Ms Havnen said she remained concerned about many elements of the 2007 intervention into Northern Territory communities, which would continue to have a psychological impact “for many years”.